Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 07-01-18 and 06-30-19 Date of Report: 07-21-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 7807 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 9 9 6.730158 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 11 77.223810 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 54 54 192.308735 $7115.4400 $37.0000
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Subtotal (Total Children Is Unduplicated) 70 74 276.262703 $7115.4400 $25.7600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 22 20.838890 $1010.6900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 41 47 34.216672 $474.5900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 105 117 89.472213 $2120.4700 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 3.466667 $294.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.716667 $36.6000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.366667 $39.5200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 24.857143 $556.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 12 8.288888 $373.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 13 9.938889 $1142.9700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 38 59 69.050000 $5178.7500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 57 92 118.851587 $8913.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 42 52.561108 $3942.0600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 36 61 91.505555 $5078.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 8.500000 $637.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 20 242.500000 $13458.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 6.150000 $461.2500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.550000 $177.5000 $50.0000
SCREEN-T1023 SCREENING 4 5 29.347620 $1467.3900 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 264 519 867.045233 $47936.5900 $55.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 39 36.205557 $181028.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.088889 $104.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 9 44.191270 $2209.5700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 4.022223 $288.0400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 66 74 80.494444 $18513.7100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 106 122.515079 $6125.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.500000 $37.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 267 392 818.149204 $40907.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.233333 $80.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 126 231.021430 $11551.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.333333 $33.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 142 355.004762 $17750.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 100 123 215.475396 $10773.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 6.422222 $160.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 31 51 145.237302 $10648.8000 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 25.714286 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 47 57 254.165073 $6354.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1313 2246 24004.273792 $1200213.6000 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1433 3406 28826.992044 $288269.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 101 129 1193.100786 $85235.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 74.033333 $4234.7000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 82 104 989.723810 $70705.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 4 50.704762 $2898.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027777 $131.8000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.005556 $229.2800 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 10.850001 $4947.6500 $456.0000
SENS -V5264 EARMOLD 8 13 18.233334 $328.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 107 133 1118.713498 $79920.8600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 8 29.647619 $411.5100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1442 7214 58703.280115 $2046297.0700 $34.8600
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Total 7807 59846.588051 $2101349.1000 $35.1100
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Number of Children (Unduplicated) With at Least One Authorization 1449